Transcript The Blueprint - West Kent CCG

A collaboration to develop
and deliver a blueprint for
a sustainable health care
system for West Kent
The Blueprint
September 2013
About this Blueprint
• This Blueprint provides an outline of how comprehensive
healthcare services for physical and mental health for all age
groups and its interactions with social care could be configured
in West Kent in the future to maintain and improve patient
experience and clinical outcomes while demand for care
increases despite increasingly tight budgetary constraints
• This Blueprint is a model for how services should be configured
regardless of the organisations involved of its delivery
• This Blueprint has been designed based on input by a broad
base of stakeholders that included representatives of all local
providers, commissioners, patients and the general public of
West Kent
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Contents
• The Challenge
• The Mapping the Future Process
• Blueprint Principles
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Hi Annie,
A letter from the present
.Sorry I missed our lunch yesterday. I had yet another doctors appointment. Between my epilepsy, diabetes and depression, I
have endless numbers of appointments at different places. And usually I have to go through my whole story again and again –
and it seems that the doctors and nurses in the different clinics do not talk with each other. I have to update the one doctor
about what was said and done at the other’s clinic. Especially for my depression, it seems the mental health team and other
doctors do not connect well.
You would need a degree to figure out my medicines – which ones to take and when. And then one doctor prescribes
something new, which then could cause problems with other pills. My GP is reluctant to change any medication because she is
worried it may somehow interfere with my epilepsy medications. Ah, I am so frustrated. It seems all I do in my life is to look
after my illnesses. Sometimes I wonder if all of these appointments are really necessary. There must be a better way. I feel
overwhelmed and out of control of what is going on with me.
Two weeks ago, I had another one of my chest infections and I found it hard to breathe at times. So I called the NHS when I
felt poorly – and before you know it, I found myself in A&E (which was totally packed with people) and after several hours
there, I got admitted. Could I not have been looked after at home?
I don’t know – all the doctors and nurses and everyone are nice, seem interested in my problems, and all are very obviously
working very hard, all are in a rush – and yet, it seems my care is getting worse, ever more fragmented, ever more rushed. I
am less and less confident that I really get all the care that I need. How do I know? I am not a doctor.
Will this get worse? The papers are full of stories about poor NHS care and government is running out of money. So will they
have to shut down some services? Will fewer staff get ever more run off their feet?
I live in West Kent and I heard that the people who are responsible for making sure we all get the care we need (They are
called CCG) have started to really look in detail how to do things differently. The programme is called Mapping the Future. I
was invited to one of their events. Really curious.... Fingers crossed they will get it right.
Take care and see you soon
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Demand keeps rising – resources stay flat
West Kent CCG budget, £M, Nominal figures, Flat cash scenario
550
545
540
CAGR 2013/14-2018/19:
2.3%
530
Commissioner’s
funding gap is
£58m in 2018/19
520
510
500
490
487
480
470
460
450
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
CCG estimate for West Kent Income (allocation)
CCG estimate for West Kent Expenditure (funding pressure)
Source: Nuffield Trust, 2012; West Kent CCG budgets 2011/12, Feb 2013; NHS, Kent County Council population estimates
Note: England population estimate 53m in 2012/13 growing to 55m in 2017/18;
West Kent population estimate 0.466m in 2012/13 growing to 0.49m in 2017/18
 These are
nominal figures,
i.e., inflation has
not been
excluded
 Providers have to
make further
efficiencies to
cover pay and
prices
5
West Kent’s rate of A&E attendances is about
average within its peer group
A&E attendance rates per 1,000 population for West Kent CCG against ONS peers
450
400
350
300
250
200
150
100
South East Coast SHA
National
50
0
While West Kent CCG
performs strongly compared
to national and SHA average,
its performance versus ONS
peers does not suggest that
improvement opportunities
have been exhausted
Source: NHS Comparators 12/13 (rolling annual up to Q2)
Note: West Kent CCG has been compared against groups in ‘Prospering Southern England’
6
West Kent’s emergency admissions rate is higher
than its peers
Emergency admission rates per 1,000 population for West Kent CCG against ONS peers
100
90
80
70
60
50
40
30
South East Coast SHA
20
National
10
0
While West Kent CCG
performs strongly compared
to national and SHA average,
its performance versus ONS
peers does not suggest that
improvement opportunities
have been exhausted
Source: NHS Comparators 12/13 (rolling annual up to Q2)
Note: West Kent CCG has been compared against groups in ‘Prospering Southern England’
7
Especially emergency admissions in
General Medicine have risen strongly
Rolling-annual Emergency Admissions at West Kent CCG for General Medicine (Apr 09 – Mar 10=100)
125
120
115
Substantial
reductions in
Length of Stay
were achieved
120.9
110
105
100
105.6
Admissions
Bed Days
95
90
85
80
Source: SUS (Apr 09 – Nov 12)
Note: Patients with LOS over a year have been excluded
8
Elective care activity in West Kent keeps going up
Rolling-annual DC, ELIP and OP activity at West Kent (Apr 09 – Mar 10=100)
160
153.9
150
140
Pembury opens Sep 2011
147
130
120
124.2
124
115.1
115
110
100
Daycase IP
Elective IP
OP
90
80
70
60
Source: SUS (Apr 09 – Nov 12)
Note: Patients with LOS over a year have been excluded
9
Doing more of the same better, faster will not be
enough
‘Scissors of Doom’
✓
Costs
Funding
✗
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Contents
• The Challenge
• The Mapping the Future Process
• Blueprint Principles
11
Mapping the Future describes what future services
should look like to help us make consistent decisions
Without an agreed vision of the
future, decisions about individual
services may be in conflict
Mapping the Future develops a Blueprint
that guides strategies of individual services
12
The MTF programme is built on a
broad base of involving patients, the
and
providers
• There have beenpublic
four events for
patient all
representatives,
clinicians, health and care
•
•
•
•
•
professionals and managers covering around four clinical topics as exemplars for
how systems could be reorganised
– Falls and mobility
– Dementia and cognitive impairment
– Urgent and emergency care
– Respiratory diseases
Participants considered why services need to change and evidence about what types
of services have been developed elsewhere
They used this and their experience and judgement to describe the characteristics of
the future health and care system
They looked at the whole spectrum of health from prevention through to recovery
and at where services and support might be best provided
The outputs from the four workshops were analysed individually – there were many
common themes. These were developed into a composite ‘first draft’ Mapping the
Future picture which was discussed at a fifth workshop on the 24th June
The Blueprint was also discussed at a 2-day People’s Forum in early September
13
The Blueprint went through several
iterations...
13 May
21 May - 7 June
7 June – End June
Early July
Early July
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... And was thoroughly tested with all
stakeholders
8-12 July
summer
early September
late September
on going
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This programme is founded on a broad
base of participation
Participating Organisations
• Members of the public
• Patient Forum
• Patient Participation Groups from several GP practices
• Age UK
• Carers First
• Meritium Independent Living
• Alzheimer’s Society
• Lucy Care Homes
• Crossroads
• White Gate Design
• Public Engagement Agency
• Local GPs
• Maidstone and Tunbridge Well NHS Trust
• Kent Community Health NHS Trust
• Kent Mental Health Partnership NHS Trust
• Southeast Coast Ambulance Service
• Health and Wellbeing Board
• Kent County Council
• NHS England Local Area Team
• NHS West Kent CCG
In total over 200
individuals
participated in the
Mapping Events and
public engagement
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Contents
• The Challenge
• The Mapping the Future Process
• Blueprint Principles
17
Mapping the Future: underlying principles
Pressures on • 4% annual growth in demand for care
West Kent • No additional funds to cover increase in demand – very likely additional pressures on
available funds (e.g., social care budget)
• Many other “boxes to tick” for provider organisations (e.g., FT applications)
• Failure of securing viability would result in take-overs, rationing and worse quality
Foundation
for our
sustainable
West Kent
• West Kent will have a clear and credible plan of services that is shared and supported
by commissioners and all providers and brings the best outcomes for local people
• The whole approach to health and care has to change – piecemeal changes focusing
on individual services and conditions will not be sufficient
• Changes must be clinician-led and involve patients and the wider public
• West Kent can learn from evidence of what was tried and what worked from
elsewhere and develop our own solution to fit our population and geography
• Instead of small pilots, West Kent will take some risk, accept that some things may
not and be adept at learning and adapting quickly
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The outcomes we should aim for
 Consistent, high quality health and social care services that are
interconnected and available round the clock
 A system that offers the most effective and efficient care so that people
get the right care in the right place by professionals with the right skills
the first time
 Proactive care which aims to prevent people from developing illnesses and
limiting the severity of their conditions
 Individuals and carers are active partners in their care, receiving
personalised and coordinated services and support
 Care is organised in a way that enables people to be as independent as
possible and to only visit hospital when it is absolutely essential
 Health and care services that are efficient in the way they use resources
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Open Questions for the Blueprint
Health and
Wellbeing
Self and Informal
Care
New Primary Care
Mobile Clinical
Services
Urgent Transfer
New Secondary
Care
System Enablers
Who sets priorities for system-wide programmes (top level governance)?
How best can the contributions of third sector organisations to health improvement be
harnessed and who should lead this?
Should there be incentives for patients for the willingness to take on greater
responsibility oneself?
How should integration with Social Services work? What parts of Social Services should
be within NPC, e.g., only free or also means-tested?
Are community care centres (incl. community hospitals) required (at what capacity), or
should mainly GP practices used as infrastructure?
Does this imply a consolidation of all rapid response services into one? Right now,
several services provide some level of MCS: GP home visits, Community rapid response
teams, OOH cars, ambulance paramedics, mental health rapid response teams
How will the necessary changes in protocols be agreed between commissioners,
ambulance service , new primary care and new secondary care? Does the organisation
have the flexibility to respond to West Kent’s specific needs?
How do we ensure Blueprint improvement levers are compatible with provider plurality
and do not reduce positive effects of choice and competition?
What technology implications are there for outreaching into community settings?
How should clinical governance be changed to underpin the respective roles and
linkages between primary and secondary care (physical and mental health)
How do we ensure integrated commissioning arrangements are clear and robust?
What funding mechanisms (e.g., Year of Care) will be deployed for Blueprint?
How far will information sharing protocols o in securing flows of patient information
between providers?
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How would any cross organisational investment in information systems be handled?
Blueprint for Physical and Mental Healthcare
HEALTH AND
WELLBEING SYSTEM
SYSTEM ENABLERS
NEW SECONDARY CARE
URGENT TRANSFER SERVICE
TERTIARY
SERVICES
MOBILE CLINICAL SERVICE
NEW PRIMARY CARE
GP Practices
Community services
MENTAL HEALTH CARE
SELF AND
INFORMAL
CARE
OOH
Social care
Expert patients
Pharmacies
Patient information
System capacity and
performance information
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The Blueprint
Health and
Wellbeing
Whole system approach with campaigns on alcohol, smoking and obesity
Communities and individuals with capacity to support themselves and each other
All levers used to tackle health determinants – e.g., Health education, environmental
health, housing eligibility and maintenance, trading standards, standards and
specifications of health and social care contracts
Self and Informal
Care
People are supported to take responsibility for their health and care
People fully informed and take part in discussions about future plans
People are supported to stay independent and at home for as long as possible
Local communities and voluntary organisations are encouraged to provide support
New Primary Care
GP practices, community services, OOH, social work and mental health as integrated
team that can respond round the clock, easily accessible, seamless service
Some services brought into community (e.g., diagnostics)
Pro-active care and prevention
Mobile Clinical
Services
Helpline for advice to patients and carers, supported by GPs and well supervised , aware
of all available services real-time
Paramedics provide care to people at the point where they become ill, as part of
integrated team with same similar pathways and protocols and access to information
Urgent Transfer
New Secondary
Care
System Enablers
Transfer patients with urgent care needs to best setting, not necessarily only to A%E
Provide a range of treatments and diagnostic tests to patients on the way
More use is made of transport services by voluntary and community organisations
Urgent and planned care are managed as separate entities for optimum efficiency
Some services concentrated in larger centres
Urgent care as part of a total system connected with NPC and Mobile Services
Clear agreements between NPC and specialists about their responsibilities and risks
Access to shared medical records and care plans for all care professionals anywhere
Improved communications and relationships between all care professionals
Risk management across the system contribute to more efficient and effective care
(financial risk and clinical governance)
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 Financial and contractual levers aligned